Seasonal Depature

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Your Name

Phone

Away Phone Number

Your Unit Number

Departure Date

Expected Return Date

Emergency Contact Name

Emergency Contact Phone

Will water be turned off in your unit? If turned off, HPCA will turn off the hot water heater breaker.

Yes

If yes, who is turning off the hot water?

Heat Source Information

Please list all heat sources and the temperature they need to be set at. Heat must be set to a minimum of 50 degrees. All thermostats must be set to at least 50 degrees before depature.

Heat Source #1 and they temperature it will be set to:

Heat Source #2 and they temperature it will be set to:

Heat Source #3 and they temperature it will be set to:

Notes

Procedure Notes from HPCA:

Your unit will be inspected once a week while you are away. During extreme cold weather your unit will be inspected more frequently and we retain the right to increase the heat settings during periods of serve colder weather.
In the event of an emergency, we will take whatever steps are necessary and advice you and/or others you designate as soon as possible.

Signature

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Name of anyone that has a key to your unit

Is anyone allowed to use your unit while you are away?

Yes

If yes, please give names and dates of use. Note: please call the office 48 hours prior to your guest arriving.

Will anyone other than HPCA employee be checking your unit while you are away?

Yes

If yes, by whom and when?

If you are parking a vehicle in the Barn parking area, what is the make, model, and registration #. Note: Maximum length is two months.

Address Where You Will Be Going

HILLTOP PLACE

New London, New Hampshire

Seasonal Depature

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